Umbilical and middle cerebral artery blood velocimetry: relationship with placental volume.

OBJECTIVE OF THE STUDY: To investigate the relationship between placental volume and the resistance of fetal arteries: umbilical and middle cerebral. MATERIAL AND METHODS: In 82 pregnant women with unaffected pregnancy between 14 and 40 weeks of gestation measurements of placental volume were made according to the parallel planimetric technique. Doppler examinations of umbilical and middle cerebral arteries were performed by means of a duplex system. RESULTS AND CONCLUSION: PI in the umbilical artery (PIUA) correlated significantly negatively with placental volume, whereas no significant correlation was found for the PI in the middle cerebral artery (PIMCA) and placental volume. Middle cerebral artery to umbilical artery PI ratio (PIMCA/PIUA ratio) showed significant positive correlation with placental volume. PIUA showed significant negative correlation with the relative volume of placenta (expressed as multiple of median for the actual gestational age) before 25 weeks of gestation and weak positive correlation with the relative volume of placenta after 25 weeks of gestation. PIMCA showed weak negative correlation with the relative volume of the placenta after 25 weeks of gestation and no correlation before 25 weeks. PIMCA/PIUA ratio showed significant positive correlation with relative placental volume before 25 weeks and significant negative correlation with relative placental volume after 25 weeks.

Prenatal screening for fetal chromosomal abnormalities using ear length and shape as an ultrasound marker.

INTRODUCTION: To determine the range of fetal ear length and ear shape variability in healthy fetuses and in fetuses with aneuploidies in the population of patients of our institution and to evaluate the clinical value of fetal ear length and shape assessment in screening for fetal aneuploidies. MATERIAL AND METHODS: Fetal ear length was determined in 210 healthy and 15 aneuploid fetuses of pregnant women undergoing targeted ultrasound examination. Fetal ear shape was assessed in the coronal section of the head and classified into one of three categories: flat, slightly protruding, markedly protruding and curved in 175 healthy and 14 aneuploid fetuses. RESULTS: Fetal ear length showed significant positive linear relationship with gestational age, which could be described by the following equation: Ear length (mm) = 0.968566 x gestational age (weeks) - 4.81629. Fetal ear shortening below 79% of expected length yielded the sensitivity of 26.7% in the detection of fetal aneuploidy at the false positive rate of 4.8%. Finding of markedly protruding and curved ears predicted fetal aneuploidy with the sensitivity of 28.6% at the false positive rate of 1.7%. The combination of fetal ear shortening below 74% of expected length or markedly protruding and curved ears resulted in the sensitivity of 33.3% and false positive rate of 3.33% in the detection of fetal aneuploidies. CONCLUSION: Fetal ear shortening has been confirmed as a marker of fetal aneuploidies. Abnormal fetal ear shape has been shown to constitute an additional marker of fetal aneuploidies, increasing the clinical value of fetal ear length measurements.

Utility of the triple test in the detection of abnormalities of the feto-placental unit.

INTRODUCTION: The objective of the study was to examine the relationship between the concentrations of maternal serum AFP, total beta-hCG and uE3 and the presence of various pathologies of the feto-placental unit. MATERIAL AND METHODS: The triple test was performed in the group of 882 pregnant women between the 14th and 21st week of gestation. The control group consisted of 863 pregnant women with unburdened obstetric anamnesis with an uneventful singleton pregnancy. The examined group consisted of 19 pregnant women with fetal aneuploidies and other pathologies of the feto-placental unit (oligohydramnios, vacuolization of the trophoblast). In the maternal sera concentrations of AFP, total beta-hCG and unconjugated estriol were determined. The risk of fetal trisomy 21 was calculated using DOWNS and PRISCA 3.0 software (cut-off 1: 295), Ulm Index was also calculated (cut-off 8.1). RESULTS: In the group of pregnant women with fetal chromosomal aneuploidies no significant changes of the examined parameters were established. In the cases of oligohydramnios AFP concentrations significantly increased, in the cases of fetal triploidy the concentrations of all examined parameters decreased. In the cases of vacuolization of the trophoblast concentration of the total beta-hCG increased. CONCLUSION: Oligohydramnios, fetal triploidy and vacuolization of the trophoblast caused significant changes of the concentrations AFP, total beta-hCG and unconjugated estriol in maternal sera.

Analysis of triple test results in 27 cases of twin pregnancies.

The study comprises 889 pregnant women between 14 and 21 weeks of gestation. The control group consisted of 862 pregnant women with unburdened obstetric anamnesis with an uneventful singleton pregnancy. The examined group consisted of 27 pregnant women with uncomplicated twin pregnancy. In the sera of pregnant women AFP (Microparticle Enzyme Immunoassay AxSYM Abbott), total beta-hCG (Microparticle Enzyme Immunoassay AxSYM Abbott) and unconjugated estriol (Radioimmunoassay Amerlex-M. 2T Johnson & Johnson Ortho Clinical Diagnostics Ltd.) were determined. The risk of fetal trisomy 21 was calculated with the use of PRISCA 3.0 software, which corrected the MoM values for twin pregnancy. Ulm Index was also calculated. In the majority of twin pregnancies increased concentrations of AFP, total beta-hCG and uE3 in the range over 1.0 MoM was noted. In the group of women below 35 years of age with singleton pregnancies using PRISCA 3.0 software it approximated to 95%. For women older than 35 optimum index for fetal trisomy 21 risk calculation was Ulm Index with the specificity 93.8%. The specificity of AFP determination in the detection of fetal open NTD in singleton pregnancy was 99%. In the group of women with twin pregnancy the obtained specificity of 77.8% for PRISCA 3.0 software is low, a more advantageous way to calculate the risk of fetal trisomy 21 is Ulm Index with the specificity of 85.2%. The specificity of AFP determination as a screening for fetal open NTD in twin pregnancy was 96.3%.

[Deficiency of maternal recognition of fetal-placental antigens in pregnancy complicated by idiopathic growth retardation]. / Zaburzenia odpowiedzi immunologicznej matki na antygeny plodowo-lozyskowe w ciazy powiklanej idiopatyczna hipotrofia.

We employed the leucocyte-migration inhibition assay to assess reactivity of cells from post-partum women to self placental antigens (SPA) and the presence of the migration inhibition blocking factor in the sera of these women. We also used complement dependent microcytotoxicity assay according to Terasaki to detect anti-fetal lymphocyte cytotoxic antibodies (AFCA) in these sera. Our study was performed in the group of 13 mothers of hypotrophic children and in the group of 14 mothers of eutrophic children. In none of the cases of both groups were AFCA detected. Using the migration inhibition assay we concluded that the deficiency of the response to ASPA occurs significantly more often in the "hypotrophic" than in the "eutrophic" mothers. Our study suggests: 1. lack of the maternal recognition of the fetus (lack of migration inhibition, or lack of the blocking factors) as the potential cause of the intrauterine growth retardation, 2. intrauterine growth retardation is not connected with the presence of AFCA in maternal serum.